Category Archives: World War 1

Post Traumatic stress disorder

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Post traumatic stress disorder

Combat Stress is here to support you

In the UK, there are various charities and service organisations dedicated to aiding veterans in readjusting to civilian life. The Royal British Legion and the more recently established Help for Heroes are two of Britain’s more high-profile veterans’ organisations which have actively advocated for veterans over the years. There has been some controversy that the NHS has not done enough in tackling mental health issues and is instead “dumping” veterans on charities such as Combat Stress.

Visit the website: www.combatstress.org.uk/veterans

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See Shell Shock – The Trauma of Battle

shellshocked-soldier-001

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BBC documentary about PTSD

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Post Traumatic Stress Disorder

PTSD

Post traumatic stress disorder (PTSD)[note 1] is a mental illness that can develop after a person is exposed to one or more traumatic events, such as sexual assault, warfare, traffic collisions, terrorism or other…

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Post Traumatic stress disorder

Post traumatic stress disorder

Combat Stress is here to support you

In the UK, there are various charities and service organisations dedicated to aiding veterans in readjusting to civilian life. The Royal British Legion and the more recently established Help for Heroes are two of Britain’s more high-profile veterans’ organisations which have actively advocated for veterans over the years. There has been some controversy that the NHS has not done enough in tackling mental health issues and is instead “dumping” veterans on charities such as Combat Stress.

Visit the website: www.combatstress.org.uk/veterans

——————————————-

See Shell Shock – The Trauma of Battle

shellshocked-soldier-001

——————————————————-

BBC documentary about PTSD

——————————————————-

Post Traumatic Stress Disorder

PTSD

Post traumatic stress disorder (PTSD)[note 1] is a mental illness that can develop after a person is exposed to one or more traumatic events, such as sexual assault, warfare, traffic collisions, terrorism or other threats on a person’s life.[1] Symptoms include disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, continue for more than a month after the occurrence of a traumatic event.[1]

Most people who have experienced a traumatizing event will not develop PTSD.[2] People who experience interpersonal trauma (e.g., sexual assault, child abuse) are more likely to develop PTSD, as opposed to people who experience non-assault based trauma such as accidents, natural disasters and witnessing trauma.[3] Children are less likely to develop PTSD after trauma than adults, especially if they are under ten years of age.[2]

Psychotherapy is the “gold standard” of treatment for PTSD. Various psychotherapies are evidence-based for PTSD, including prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, cognitive restructuring therapy, trauma-focused cognitive behavioral therapy, brief eclectic psychotherapy, narrative therapy, and stress inoculation training.[4][5] Therapists generally meet one-on-one with individuals with PTSD, but frequently group therapy or more intensive settings are also beneficial. Serotonergic antidepressants (such as fluoxetine and paroxetine, which are the only medications FDA approved for PTSD) are the first-line pharmacologic agents used for PTSD, but medications are best used as in addition to psychotherapy as they rarely result in recovery from PTSD, alone.[4][6][7][8] Most other medications do not have enough evidence to support their use, may only improve symptoms a small amount without resulting in functional recovery, or, in the case of benzodiazepines, have actually been found to worsen and prolong PTSD, including inhibiting the benefits of psychotherapy.[9][10]

The term “posttraumatic stress disorder” was coined in the early 1970s in large part due to diagnoses of US military veterans of the Vietnam War.[11] It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).[12] Trauma-related mental disorders have been documented since at least the 17th century, and became more commonly recognized during the World Wars under various terms including “shell shock,” “combat fatigue,” and “war neurosis.”

Classification

Posttraumatic stress disorder was classified as an anxiety disorder in the DSM-IV, but has since been reclassified as a “trauma- and stressor-related disorder” in DSM-5. The characteristic symptoms are not present before exposure to the violently traumatic event. In the typical case, the individual with PTSD persistently avoids trauma-related thoughts and emotions, and discussion of the traumatic event, and may even have amnesia of the event. However, the event is commonly relived by the individual through intrusive, recurrent recollections, flashbacks, and nightmares.[15] While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life and/or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder).[1][16][17][18]

Risk factors

No quieren (They do not want to) by Francisco Goya (1746–1828) depicts an elderly woman wielding a knife in defense of a girl being assaulted by a soldier.[19]

PTSD is believed to be caused by the experience of a wide range of traumatic events and, in particular if the trauma is extreme, can occur in persons with no predisposing conditions.[20][21]

Persons considered at risk include, for example, combat military personnel, victims of natural disasters, concentration camp survivors, and victims of violent crime. Individuals frequently experience “survivor’s guilt” for remaining alive while others died. Causes of the symptoms of PTSD are the experiencing or witnessing of a stressor event involving death, serious injury or such threat to the self or others in a situation in which the individual felt intense fear, horror, or powerlessness.[22] Persons employed in occupations that expose them to violence (such as soldiers) or disasters (such as emergency service workers) are also at risk.[22]

Children or adults may develop PTSD symptoms by experiencing bullying.[23]

Several biological indicators have been identified that are related to later PTSD development. Heightened startle responses and a smaller hippocampal volume have been identified as biomarkers for the risk of developing PTSD.[24] Additionally, one study found that soldiers whose leukocytes had greater numbers of glucocorticoid receptors were more prone to developing PTSD after experiencing trauma.[24]

Genetics

There is evidence that susceptibility to PTSD is hereditary. Approximately 30% of the variance in PTSD is caused from genetics alone. For twin pairs exposed to combat in Vietnam, having a monozygotic (identical) twin with PTSD was associated with an increased risk of the co-twin’s having PTSD compared to twins that were dizygotic (non-identical twins).[25] There is evidence that those with a genetically smaller hippocampus are more likely to develop PTSD following a traumatic event. Research has also found that PTSD shares many genetic influences common to other psychiatric disorders. Panic and generalized anxiety disorders and PTSD share 60% of the same genetic variance. Alcohol, nicotine, and drug dependence share greater than 40% genetic similarities.[26]

Trauma

Most people will experience at least one traumatizing event in their lifetime.[27] Men are more likely to experience a traumatic event, but women are more likely to experience the kind of high-impact traumatic event that can lead to PTSD, such as interpersonal violence and sexual assault.[2]

Posttraumatic stress reactions have not been studied as well in children and adolescents as adults.[2] The rate of PTSD may be lower in children than adults, but in the absence of therapy, symptoms may continue for decades.[2] One estimate suggests that the proportion of children and adolescents having PTSD in a non-wartorn population in a developed country may be 1% compared to 1.5% to 3% of adults, and much lower below the age of 10 years.[2]

Predictor models have consistently found that childhood trauma, chronic adversity, and familial stressors increase risk for PTSD as well as risk for biological markers of risk for PTSD after a traumatic event in adulthood.[28][29][30] Peritraumatic dissociation in children is a predictive indicator of the development of PTSD later in life.[26] This effect of childhood trauma, which is not well-understood, may be a marker for both traumatic experiences and attachment problems.[31][32] Proximity to, duration of, and severity of the trauma make an impact, and interpersonal traumas cause more problems than impersonal ones.[33]

Quasi-experimental studies have demonstrated a relationship between intrusive thoughts and intentional control responses such that suppression increases the frequency of unwanted intrusive thoughts. These results suggest that suppression of intrusive thoughts may be important in the development and maintenance of PTSD.[34]

Foster care

Adults who were in foster care as children have a higher rate of PTSD.[medical citation needed]

Domestic violence

An individual that has been exposed to domestic violence is predisposed to the development of PTSD. However, being exposed to a traumatic experience does not automatically indicate that an individual will develop PTSD.[16] There is a strong association between the development of PTSD in mothers that experienced domestic violence during the perinatal period of their pregnancy.[35]

Military experience

A U.S. Long-Range Patrol team leader in Vietnam, 1968.
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BBC Interview PTSD Treatment
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Early intervention appears to be a critical preventive measure.[36] Studies have shown that soldiers prepared for the potential of a traumatic experience are more prepared to deal with the stress of a traumatic experience and therefore less likely to develop PTSD.[16]

Among American troops in Vietnam a greater portion of women experienced high levels of war-zone stress compared to theater men—39.9 percent versus 23.5 percent. The key to this fact is that the vast majority (6,250 or 83.3%) of the women who served in the war zone were nurses who dealt almost daily with death. Black veterans had nearly 2.5 fold the risk of developing war zone-related PTSD as compared to white/other veterans. Hispanics had more than three times the risk. But the most revealing fact, theater veterans injured or wounded in combat had nearly four times the risk of developing PTSD compared to those not injured/wounded according to two key studies—the August 2014 National Vietnam Veterans Longitudinal Study (NVVLS). Paired with the late 1980s National Vietnam Veterans Readjustment Study (NVVRS).[37]

The long-term medical consequence of PTSD among male veterans who served in the Vietnam War was that they were almost twice as likely to die in the quarter of a century between the two key studies than those who did not have PTSD. It was also found those with PTSD were more likely to die of chronic conditions such as cancer, nervous system disorders, and musculoskeletal problems. The etiology of this relationship is not certain other than lingering stress from combat such as nightmares, intrusive memories, and hyper-vigilance are aggravating factors contributing to psychological and physiological illnesses.[37]

The racial similarity between Hispanic and Vietnamese soldiers, and the discrimination Hispanic soldiers faced from their own military, made it difficult for Hispanic soldiers to dehumanize their enemy. Hispanic veterans who reported experiencing racial discrimination during their service displayed more symptoms of PTSD than Hispanic veterans who did not.[38]

PTSD is under-diagnosed in female veterans.[39] Sexual assault in the military is a leading cause for female soldiers developing PTSD; a female soldier who is sexually assaulted while serving in the military is nine times more likely to develop PTSD than a female soldier who is not assaulted. A soldier’s assailant may be her colleague or superior officer, making it difficult for her to both report the crime and to avoid interacting with her assailant again.[40] Until the Tailhook scandal drew attention to the problem, the role that sexual assault in the military plays in female veterans developing PTSD went largely unstudied.[41]

Protective effects include social support, which also helps with recovery if PTSD develops.[42][43] For more aggravating factors to recovery once home, see social alienation among returning war veterans.

Drug and substance abuse

Drug abuse and alcohol abuse commonly co-occur with PTSD.[44] Recovery from posttraumatic stress disorder or other anxiety disorders may be hindered, or the condition worsened, by medication or substance overuse, abuse, or dependence; resolving these problems can bring about a marked improvement in an individual’s mental health status and anxiety levels.[45][46]

Pathophysiology

Neuroendocrinology

PTSD symptoms may result when a traumatic event causes an over-reactive adrenaline response, which creates deep neurological patterns in the brain. These patterns can persist long after the event that triggered the fear, making an individual hyper-responsive to future fearful situations.[16][47] During traumatic experiences the high levels of stress hormones secreted suppress hypothalamic activity that may be a major factor toward the development of PTSD.[48]

PTSD causes biochemical changes in the brain and body, that differ from other psychiatric disorders such as major depression. Individuals diagnosed with PTSD respond more strongly to a dexamethasone suppression test than individuals diagnosed with clinical depression.[49][50]

In addition, most people with PTSD also show a low secretion of cortisol and high secretion of catecholamines in urine,[51] with a norepinephrine/cortisol ratio consequently higher than comparable non-diagnosed individuals.[52] This is in contrast to the normative fight-or-flight response, in which both catecholamine and cortisol levels are elevated after exposure to a stressor.[53]

Brain catecholamine levels are high,[54] and corticotropin-releasing factor (CRF) concentrations are high.[55][56] Together, these findings suggest abnormality in the hypothalamic-pituitary-adrenal (HPA) axis.

The HPA axis is responsible for coordinating the hormonal response to stress.[26] Given the strong cortisol suppression to dexamethasone in PTSD, HPA axis abnormalities are likely predicated on strong negative feedback inhibition of cortisol, itself likely due to an increased sensitivity of glucocorticoid receptors.[57]

Translating this reaction to human conditions gives a pathophysiological explanation for PTSD by a maladaptive learning pathway to fear response through a hypersensitive, hyperreactive, and hyperresponsive HPA axis.[58]

Low cortisol levels may predispose individuals to PTSD: Following war trauma, Swedish soldiers serving in Bosnia and Herzegovina with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD symptoms, following war trauma, than soldiers with normal pre-service levels.[59] Because cortisol is normally important in restoring homeostasis after the stress response, it is thought that trauma survivors with low cortisol experience a poorly contained—that is, longer and more distressing—response, setting the stage for PTSD.

Other studies indicate that people that suffer from PTSD have chronically low levels of serotonin, which contributes to the commonly associated behavioral symptoms such as anxiety, ruminations, irritability, aggression, suicidality, and impulsivity.[60] Serotonin also contributes to the stabilization of glucocorticoid production.

Dopamine levels in a person with PTSD can help contribute to the symptoms associated. Low levels of dopamine can contribute to anhedonia, apathy, impaired attention, and motor deficits. Increased levels of dopamine can cause psychosis, agitation, and restlessness.[60]

Hyperresponsiveness in the norepinephrine system can be caused by continued exposure to high stress. Overactivation of norepinephrine receptors in the prefrontal cortex can be connected to the flashbacks and nightmares frequently experienced by those with PTSD. A decrease in other norepinephrine functions (awareness of the current environment) prevents the memory mechanisms in the brain from processing that the experience, and emotions the person is experiencing during a flashback are not associated with the current environment.[60]

However, there is considerable controversy within the medical community regarding the neurobiology of PTSD. A review of existing studies on this subject showed no clear relationship between cortisol levels and PTSD. However, the majority of reports indicate people with PTSD have elevated levels of corticotropin-releasing hormone, lower basal cortisol levels, and enhanced negative feedback suppression of the HPA axis by dexamethasone

Three areas of the brain in which function may be altered in PTSD have been identified: the prefrontal cortex, amygdala, and hippocampus. Much of this research has utilised PTSD victims from the Vietnam War. For example, a prospective study using the Vietnam Head Injury Study showed that damage to the prefrontal cortex may actually be protective against later development of PTSD.[63] In a study by Gurvits et al., combat veterans of the Vietnam War with PTSD showed a 20% reduction in the volume of their hippocampus compared with veterans having suffered no such symptoms.[64] This finding could not be replicated in chronic PTSD patients traumatized at an air show plane crash in 1988 (Ramstein, Germany).[65]

In human studies, the amygdala has been shown to be strongly involved in the formation of emotional memories, especially fear-related memories. Neuroimaging studies in humans have revealed both morphological and functional aspects of PTSD.[66] However, during high stress times the hippocampus, which is associated with the ability to place memories in the correct context of space and time, and with the ability to recall the memory, is suppressed. This suppression is hypothesized to be the cause of the flashbacks that often affect people with PTSD. When someone with PTSD undergoes stimuli similar to the traumatic event, the body perceives the event as occurring again because the memory was never properly recorded in the person’s memory.[26][67][unreliable medical source?]

The amygdalocentric model of PTSD proposes that it is associated with hyperarousal of the amygdala and insufficient top-down control by the medial prefrontal cortex and the hippocampus in particular during extinction.[68] This is consistent with an interpretation of PTSD as a syndrome of deficient extinction ability.[68][69] A study at the European Neuroscience Institute-Goettingen (Germany) found that fear extinction-induced IGF2/IGFBP7 signalling promotes the survival of 17–19-day-old newborn hippocampal neurons. This suggests that therapeutic strategies that enhance IGF2 signalling and adult neurogenesis might be suitable to treat diseases linked to excessive fear memory such as PTSD.[70] Further animal and clinical research into the amygdala and fear conditioning may suggest additional treatments for the condition.

The maintenance of the fear involved with PTSD has been shown to include the HPA axis, the locus coeruleusnoradrenergic systems, and the connections between the limbic system and frontal cortex. The HPA axis that coordinates the hormonal response to stress,[71] which activates the LC-noradrenergic system, is implicated in the over-consolidation of memories that occurs in the aftermath of trauma.[72] This over-consolidation increases the likelihood of one’s developing PTSD. The amygdala is responsible for threat detection and the conditioned and unconditioned fear responses that are carried out as a response to a threat.[26]

The LCnoradrenergic system has been hypothesized to mediate the over-consolidation of fear memory in PTSD. High levels of cortisol reduce noradrenergic activity, and because people with PTSD tend to have reduced levels of cortisol, it is proposed that individuals with PTSD fail to regulate the increased noradrenergic response to traumatic stress.[73] It is thought that the intrusive memories and conditioned fear responses to associated triggers is a result of this response. Neuropeptide Y has been reported to reduce the release of norepinephrine and has been demonstrated to have anxiolytic properties in animal models. Studies have shown people with PTSD demonstrate reduced levels of NPY, possibly indicating their increased anxiety levels.[26]

The basolateral nucleus (BLA) of the amygdala is responsible for the comparison and development of associations between unconditioned and conditioned responses to stimuli, which results in the fear conditioning present in PTSD. The BLA activates the central nucleus (CeA) of the amygdala, which elaborates the fear response, (including behavioral response to threat and elevated startle response). Descending inhibitory inputs from the medial prefrontal cortex (mPFC) regulate the transmission from the BLA to the CeA, which is hypothesized to play a role in the extinction of conditioned fear responses.[26]

Studies have also shown that PTSD patients show hypoactiviation or decreased brain activity in the dorsal and rostral anterior cingulate cortices and the ventromedial prefrontal cortex, areas linked to the experience and regulation of emotion.[74]

Diagnosis

Screening and assessment

A number of screening instruments, including the UCLA PTSD Index for DSM-IV, which have good reliability and validity, are used for the screening of PTSD for children and young adults.[75] Primary Care PTSD Screen and PTSD Checklist are other screening tools.[76]

The American Academy of Child and Adolescent Psychiatry practice parameters is a guidelines for the assessment and treatment of PTSD.[77]

Diagnostic and statistical manual

Since the introduction of DSM-IV, the number of possible events that might be used to diagnose PTSD has increased; one study suggests that the increase is around 50%.[78] Various scales to measure the severity and frequency of PTSD symptoms exist.[79][80] Standardized screening tools such as Trauma Screening Questionnaire[81] and PTSD Symptom Scale[82] can be used to detect possible symptoms of posttraumatic stress disorder and suggest the need for a formal diagnostic assessment.

In DSM-5, published in May, 2013, PTSD is classified as a trauma- and stress-related disorder.[1]

International classification of diseases

The diagnostic criteria for PTSD, stipulated in the International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10), may be summarized as:[83]

  • Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
  • Persistent remembering, or “reliving” the stressor by intrusive flash backs, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor.
  • Actual or preferred avoidance of circumstances resembling or associated with the stressor (not present before exposure to the stressor).
  • Either (1) or (2):
  1. Inability to recall, either partially or completely, some important aspects of the period of exposure to the stressor
  2. Persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor) shown by any two of the following:
  • difficulty in falling or staying asleep
  • irritability or outbursts of anger
  • difficulty in concentrating
  • hyper-vigilance
  • exaggerated startle response.

The International Statistical Classification of Diseases and Related Health Problems 10 diagnostic guidelines state:[83] In general, this disorder should not be diagnosed unless there is evidence that it arose within 6 months of a traumatic event of exceptional severity. A “probable” diagnosis might still be possible if the delay between the event and the onset was longer than 6 months, provided that the clinical manifestations are typical and no alternative identification of the disorder (e.g., as an anxiety or obsessive-compulsive disorder or depressive episode) is plausible. In addition to evidence of trauma, there must be a repetitive, intrusive recollection or re-enactment of the event in memories, daytime imagery, or dreams. Conspicuous emotional detachment, numbing of feeling, and avoidance of stimuli that might arouse recollection of the trauma are often present but are not essential for the diagnosis. The autonomic disturbances, mood disorder, and behavioural abnormalities all contribute to the diagnosis but are not of prime importance. The late chronic sequelae of devastating stress, i.e. those manifest decades after the stressful experience, should be classified under F62.0.

Differential diagnosis

A diagnosis of PTSD requires exposure to an extreme stressor such as one that is life-threatening. Any stressor can result in a diagnosis of adjustment disorder and it is an appropriate diagnosis for a stressor and a symptom pattern that does not meet the criteria for PTSD, for example a stressor like a partner being fired, or a spouse leaving. If any of the symptom pattern is present before the stressor, another diagnosis is required, such as brief psychotic disorder or major depressive disorder. Other differential diagnoses are schizophrenia or other disorders with psychotic features such as Psychotic disorders due to a general medical condition. Drug-induced psychotic disorders can be considered if substance abuse is involved.[15]

The symptom pattern for acute stress disorder must occur and be resolved within four weeks of the trauma. If it lasts longer, and the symptom pattern fits that characteristic of PTSD, the diagnosis may be changed.[15]

Obsessive compulsive disorder may be diagnosed for intrusive thoughts that are recurring but not related to a specific traumatic event.[15]

Malingering should be considered if a financial and/or legal advantage is a possibility.

Prevention

Modest benefits have been seen from early access to cognitive behavioral therapy.[84] Critical incident stress management has been suggested as a means of preventing PTSD, but subsequent studies suggest the likelihood of its producing negative outcomes.[85][86] A review “…did not find any evidence to support the use of an intervention offered to everyone”, and that “…multiple session interventions may result in worse outcome than no intervention for some individuals.”[87] The World Health Organization recommends against the use of benzodiazepines and antidepressants in those having experienced trauma.[88] Some evidence supports the use of hydrocortisone for prevention in adults, however no evidence supports propranolol, escitalopram, temazepam, or gabapentin.[89] In fact, taking benzodiazepines after trauma is associated with a 2-5 times increased risk of developing PTSD and major depressive disorder.[9]

Psychological debriefing

Trauma-exposed individuals often receive treatment called psychological debriefing in an effort to prevent PTSD.[84] Several meta-analyses; however, find that psychological debriefing is unhelpful and is potentially harmful.[84][90][91] This is true for both single-session debriefing and multiple session interventions.[87] The American Psychological Association judges the status of psychological debriefing as No Research Support/Treatment is Potentially Harmful.[92]

Psychological debriefing was; however, the most often used preventive measure, partly because of the relative ease with which this treatment can be given to individuals directly following an event. It consists of interviews that are meant to allow individuals to directly confront the event and share their feelings with the counselor and to help structure their memories of the event.[84]

Risk-targeted interventions

For one such method, see trauma risk management.

Risk-targeted interventions are those that attempt to mitigate specific formative information or events. It can target modeling normal behaviors, instruction on a task, or giving information on the event.[93][94]

Management

An assistance dog trained to help veterans with PTSD

Psychological

Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling practices common to many treatment responses for PTSD include education about the condition and provision of safety and support.[16][82]

The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral programs, variants of exposure therapy[citation needed], stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR),[95] mindfulness-based meditation[96] and many combinations of these procedures.[97]

EMDR and trauma-focused cognitive behavioral therapy (TFCBT) were recommended as first-line treatments for trauma victims in a 2007 review; however, “the evidence base [for EMDR] was not as strong as that for TFCBT … Furthermore, there was limited evidence that TFCBT and EMDR were superior to supportive/non-directive treatments, hence it is highly unlikely that their effectiveness is due to non-specific factors such as attention.”[98] A meta-analytic comparison of EMDR and cognitive behavioral therapy found both protocols indistinguishable in terms of effectiveness in treating PTSD; however, “the contribution of the eye movement component in EMDR to treatment outcome” is unclear.[99]

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) seeks to change the way a trauma victim feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. CBT has been proven to be an effective treatment for PTSD and is currently considered the standard of care for PTSD by the United States Department of Defense.[100] In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts. The goal is to understand how certain thoughts about events cause PTSD-related stress.

Recent research on contextually based third-generation behavior therapies suggests that they may produce results comparable to some of the better validated therapies.[101] Many of these therapy methods have a significant element of exposure[100] and have demonstrated success in treating the primary problems of PTSD and co-occurring depressive symptoms.[102]

Exposure therapy is a type of cognitive behavioral therapy[103] that involves assisting trauma survivors to re-experience distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders; this therapy modality is well supported by clinical evidence[citation needed]. The success of exposure-based therapies has raised the question of whether exposure is a necessary ingredient in the treatment of PTSD.[104] Some organizations[which?] have endorsed the need for exposure.[105][106] The US Department of Veterans Affairs has been actively training mental health treatment staff in prolonged exposure therapy[107] and Cognitive Processing Therapy[108] in an effort to better treat US veteranswith PTSD.

Eye movement desensitization and reprocessing

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed and studied by Francine Shapiro.[109] She had noticed that, when she was thinking about disturbing memories herself, her eyes were moving rapidly. When she brought her eye movements under control while thinking, the thoughts were less distressing.[109]

In 2002, Shapiro and Maxfield published a theory of why this might work, called adaptive information processing.[110] This theory proposes that eye movement can be used to facilitate emotional processing of memories, changing the person’s memory to attend to more adaptive information.[111] The therapist initiates voluntary rapid eye movements while the person focuses on memories, feelings or thoughts about a particular trauma.[2][112] The therapists uses hand movements to get the person to move their eyes backward and forward, but hand-tapping or tones can also be used.[2] EMDR closely resembles cognitive behavior therapy as it combines exposure (re-visiting the traumatic event), working on cognitive processes and relaxation/self-monitoring.[2] However, exposure by way of being asked to think about the experience rather than talk about it has been highlighted as one of the more important distinguishing elements of EMDR.[113]

There have been multiple small controlled trials of four to eight weeks of EMDR in adults[114] as well as children and adolescents.[112] EMDR reduced PTSD symptoms enough in the short term that one in two adults no longer met the criteria for PTSD, but the number of people involved in these trials was small.[114] There was not enough evidence to know whether or not EMDR could eliminate PTSD.[114] There was some evidence that EMDR might prevent depression.[114] There were no studies comparing EMDR to other psychological treatments or to medication.[114] Adverse effects were largely unstudied.[114] The benefits were greater for women with a history of sexual assault compared with people who had experienced other types of traumatizing events (such as accidents, physical assaults and war). There is a small amount of evidence that EMDR may improve re-experiencing symptoms in children and adolescents, but EMDR has not been shown to improve other PTSD symptoms, anxiety, or depression.[112]

The eye movement component of the therapy may not be critical for benefit.[2][111] As there has been no major, high quality randomized trial of EMDR with eye movements versus EMDR without eye movements, the controversy over effectiveness is likely to continue.[113] Authors of a meta-analysis published in 2013 stated, “We found that people treated with eye movement therapy had greater improvement in their symptoms of post-traumatic stress disorder than people given therapy without eye movements….Secondly we found that that in laboratory studies the evidence concludes that thinking of upsetting memories and simultaneously doing a task that facilitates eye movements reduces the vividness and distress associated with the upsetting memories.”[95]

Interpersonal psychotherapy

Other approaches, in particular involving social supports,[42][43] may also be important. An open trial of interpersonal psychotherapy[115] reported high rates of remission from PTSD symptoms without using exposure.[116] A current, NIMH-funded trial in New York City is now (and into 2013) comparing interpersonal psychotherapy, prolonged exposure therapy, and relaxation therapy.[117][full citation needed][118][119]

Medication

Most medications do not have enough evidence to support their use.[10] With many medications, residual symptoms following treatment is the rule rather than the exception.[120]

SSRIs and SNRIs

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may have some benefit for PTSD symptoms.[10][121] Tricyclic antidepressants are equally effective but are less well tolerated.[122] Evidence provides support for a small or modest improvement with sertraline, fluoxetine, paroxetine, and venlafaxine.[10][123] Thus, these four medications are considered to be first-line medications for PTSD.[121][124]

Benzodiazepines

Benzodiazepines are not recommended for the treatment of PTSD due to a lack of evidence of benefit and risk of worsening PTSD symptoms.[9][125] Some authors believe that the use of benzodiazepines is contraindicated for acute stress, as this group of drugs promotes dissociation and ulterior revivals.[126] Nevertheless, some use benzodiazepines with caution for short-term anxiety and insomnia.[127][128][129] While benzodiazepines can alleviate acute anxiety, there is no consistent evidence that they can stop the development of PTSD and may actually increase the risk of developing PTSD 2-5 times.[9] Additionally, benzodiazepines may reduce the effectiveness of psychotherapeutic interventions, and there is some evidence that benzodiazepines may actually contribute to the development and chronification of PTSD. For those who already have PTSD, benzodiazepines may worsen and prolong the course of illness, by worsening psychotherapy outcomes, and causing or exacerbating aggression, depression (including suicidality), and substance use.[9] Other drawbacks include the risk of developing a benzodiazepine dependence, tolerance (i.e., short-term benefits wearing off with time), and withdrawal syndrome; additionally, individuals with PTSD (even those without a history of alcohol or drug misuse) are at an increased risk of abusing benzodiazepines.[9][124][130] Due to a plethora of other treatments with greater efficacy for PTSD and less risks (e.g., prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, cognitive restructuring therapy, trauma-focused cognitive behavioral therapy, brief eclectic psychotherapy, narrative therapy, stress inoculation training, serotonergic antidepressants, adrenergic inhibitors, antipsychotics, and even anticonvulsants), benzodiazepines should be considered relatively contraindicated until all other treatment options are exhausted.[4][5][9] For those who argue that benzodiazepines should be used sooner in the most severe cases, the adverse risk of disinhibition (associated with suicidality, aggression and crimes) and clinical risks of delaying or inhibiting definitive efficacious treatments, make other alternative treatments preferable (e.g., inpatient, residential, partial hospitalization, intensive outpatient, dialectic behavior therapy; and other fast-acting sedating medications such as trazodone, mirtazapine, amitripytline, doxepin, prazosin, propranolol, guanfacine, clonidine, quetiapine, olanzapine, valproate, gabapentin).[4][7][8] “PTSD recovery should denote improved functioning (e.g. healthy relationships, employment), not simply sedation…. For years, sedatives were the only thing we had in our armamentarium for PTSD. Now, we have many more tools and our patients – whether survivors of assault, combat or any other trauma – deserve those treatments that have proven to be safer and more effective.”[9]

Glucocorticoids

Glucocorticoids may be useful for short-term therapy to protect against neurodegeneration caused by the extended stress response that characterizes PTSD, but long-term use may actually promote neurodegeneration.[131]

Cannabinoids

The cannabinoid nabilone is sometimes used off-label for nightmares in PTSD. Although some short-term benefit was shown, adverse effects are common and it has not been adequately studied to determine efficacy.[132] Additionally, there are other treatments with stronger efficacy and less risks (e.g., psychotherapy, serotonergic antidepressants, adrenergic inhibitors).

Other

Exercise, sport and physical activity

Physical activity can have an impact on people’s psychological wellbeing[133] and physical health.[134] The U.S. National Center for PTSD recommends moderate exercise as a way to distract from disturbing emotions, build self-esteem and increase feelings of being in control again. They recommend a discussion with a doctor before starting an exercise program.[135]

Play therapy for children

Play is thought to help children link their inner thoughts with their outer world, connecting real experiences with abstract thought.[136] Repetitive play can also be one of the ways a child relives traumatic events, and that can be a symptom of traumatization in a child or young person.[137] Although it is commonly used, there have not been enough studies comparing outcomes in groups of children receiving and not receiving play therapy, so the effects of play therapy are not yet understood.[2][136]

Military programs

Many veterans of the wars in Iraq and Afghanistan have faced significant physical, emotional, and relational disruptions. In response, the United States Marine Corps has instituted programs to assist them in re-adjusting to civilian life, especially in their relationships with spouses and loved ones, to help them communicate better and understand what the other has gone through.[138] Walter Reed Army Institute of Research (WRAIR) developed the Battlemind program to assist service members avoid or ameliorate PTSD and related problems.

Epidemiology

Disability-adjusted life year rates for posttraumatic stress disorder per 100,000 inhabitants in 2004.[139]

  no data
  < 43.5
  43.5-45
  45-46.5
  46.5-48
  48-49.5
  49.5-51
  51-52.5
  52.5-54
  54-55.5
  55.5-57
  57–58.5
  > 58.5

There is debate over the rates of PTSD found in populations, but, despite changes in diagnosis and the criteria used to define PTSD between 1997 and 2007, epidemiological rates have not changed significantly.[140]

The United Nations’ World Health Organization publishes estimates of PTSD impact for each of its member states; the latest data available are for 2004. Considering only the 25 most populated countries ranked by overall age-standardized Disability-Adjusted Life Year (DALY) rate, the top half of the ranked list is dominated by Asian/Pacific countries, the US, and Egypt.[141] Ranking the countries by the male-only or female-only rates produces much the same result, but with less meaningfulness, as the score range in the single-sex rankings is much-reduced (4 for women, 3 for men, as compared with 14 for the overall score range), suggesting that the differences between female and male rates, within each country, is what drives the distinctions between the countries.[142][143]

Age-standardized Disability-adjusted life year (DALY) rates for PTSD, per 100,000 inhabitants, in 25 most populous countries, ranked by overall rate (2004)
Region Country PTSD DALY rate,
overall[141]
PTSD DALY rate,
females[142]
PTSD DALY rate,
males[143]
Asia / Pacific Thailand 59 86 30
Asia / Pacific Indonesia 58 86 30
Asia / Pacific Philippines 58 86 30
Americas USA 58 86 30
Asia / Pacific Bangladesh 57 85 29
Africa Egypt 56 83 30
Asia / Pacific India 56 85 29
Asia / Pacific Iran 56 83 30
Asia / Pacific Pakistan 56 85 29
Asia / Pacific Japan 55 80 31
Asia / Pacific Myanmar 55 81 30
Europe Turkey 55 81 30
Asia / Pacific Vietnam 55 80 30
Europe France 54 80 28
Europe Germany 54 80 28
Europe Italy 54 80 28
Asia / Pacific Russian Federation 54 78 30
Europe United Kingdom 54 80 28
Africa Nigeria 53 76 29
Africa Dem. Republ. of Congo 52 76 28
Africa Ethiopia 52 76 28
Africa South Africa 52 76 28
Asia / Pacific China 51 76 28
Americas Mexico 46 60 30
Americas Brazil 45 60 30

United States

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US Army Infantryman talks about PTSD

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The National Comorbidity Survey Replication has estimated that the lifetime prevalence of PTSD among adult Americans is 6.8%, with women (9.7%) more than twice as likely as men[60] (3.6%) to have PTSD at some point in their lives.[144] More than 60% of men and more than 60% of women experience at least one traumatic event in their life. The most frequently reported traumatic events by men are rape, combat, and childhood neglect or physical abuse. Women most frequently report instances of rape, sexual molestation, physical attack, being threatened with a weapon and childhood physical abuse.[60] 88% of men and 79% of women with lifetime PTSD have at least one comorbid psychiatric disorder. Major depressive disorder, 48% of men and 49% of women, and lifetime alcohol abuse or dependence, 51.9% of men and 27.9% of women, are the most common comorbid disorders.[145]

The United States Department of Veterans Affairs estimates that 830,000 Vietnam War veterans suffered symptoms of PTSD.[146] The National Vietnam Veterans’ Readjustment Study (NVVRS) found 15.2% of male and 8.5% of female Vietnam veterans to suffer from current PTSD at the time of the study. Life-Time prevalence of PTSD was 30.9% for males and 26.9% for females. In a reanalysis of the NVVRS data, along with analysis of the data from the Matsunaga Vietnam Veterans Project, Schnurr, Lunney, Sengupta, and Waelde found that, contrary to the initial analysis of the NVVRS data, a large majority of Vietnam veterans suffered from PTSD symptoms (but not the disorder itself). Four out of five reported recent symptoms when interviewed 20–25 years after Vietnam.[147]

A 2011 study from Georgia State University and San Diego State University found that rates of PTSD diagnosis increased significantly when troops were stationed in combat zones, had tours of longer than a year, experienced combat, or were injured. Military personnel serving in combat zones were 12.1 percentage points more likely to receive a PTSD diagnosis than their active-duty counterparts in non-combat zones. Those serving more than 12 months in a combat zone were 14.3 percentage points more likely to be diagnosed with PTSD than those having served less than one year. Experiencing an enemy firefight was associated a 18.3 percentage point increase in the probability of PTSD, while being wounded or injured in combat was associated a 23.9 percentage point increase in the likelihood of a PTSD diagnosis. For the 2.16 million U.S. troops deployed in combat zones between 2001 and 2010, the total estimated two-year costs of treatment for combat-related PTSD are between $1.54 billion and $2.69 billion.[148]

As of 2013, rates of PTSD have been estimated at up to 20% for veterans returning from Iraq and Afghanistan.[27] As of 2013 13% of veterans returning from Iraq were unemployed.[149]

Society and culture

United States—veterans

Other countries—veterans

In the UK, there are various charities and service organisations dedicated to aiding veterans in readjusting to civilian life. The Royal British Legion and the more recently established Help for Heroes are two of Britain’s more high-profile veterans’ organisations which have actively advocated for veterans over the years. There has been some controversy that the NHS has not done enough in tackling mental health issues and is instead “dumping” veterans on charities such as Combat Stress.[150][151]

Veterans Affairs Canada offers a new program that includes rehabilitation, financial benefits, job placement, health benefits program, disability awards, peer support[152][153][154] and family support.[155]

History

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Shell Shock in WWI

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The 1952 edition of the DSM-I includes a diagnosis of “gross stress reaction”, which bears striking similarities to the modern definition and understanding of PTSD.[156] Gross stress reaction is defined as a “normal personality [utilizing] established patterns of reaction to deal with overwhelming fear” as a response to “conditions of great stress”.[157] The diagnosis includes language which relates the condition to combat as well as to “civilian catastrophe”.[157]

Early in 1978, the term was used in a working group finding presented to the Committee of Reactive Disorders.[158] The condition was added to the DSM-III, which was being developed in the 1980s, as posttraumatic stress disorder.[156][158] In the DSM-IV, the spelling “posttraumatic stress disorder” is used, while in the ICD-10, the spelling is “post-traumatic stress disorder”.[159]

The addition of the term to the DSM-III was greatly influenced by the experiences and conditions of US military veterans of the Vietnam War.[11] Due to its association with the war in Vietnam, PTSD has become synonymous with many historical war-time diagnoses such as railway spine, stress syndrome, nostalgia, soldier’s heart, shell shock, battle fatigue, combat stress reaction, or traumatic war neurosis.[160][161] Some of these terms date back to the 19th century, which is indicative of the universal nature of the condition. In a similar vein, psychiatrist Jonathan Shay has proposed that Lady Percy‘s soliloquy in the William Shakespeare play Henry IV, Part 1 (act 2, scene 3, lines 40–62[162]), written around 1597, represents an unusually accurate description of the symptom constellation of PTSD.[163]

Statue, Three Servicemen, Vietnam Veterans Memorial

The correlations between combat and PTSD are undeniable; according to Stéphane Audoin-Rouzeau and Annette Becker, “One-tenth of mobilized American men were hospitalized for mental disturbances between 1942 and 1945, and, after thirty-five days of uninterrupted combat, 98% of them manifested psychiatric disturbances in varying degrees.”[164] In fact, much of the available published research regarding PTSD is based on studies done on veterans of the war in Vietnam. A study based on personal letters from soldiers of the 18th-century Prussian Army concludes that combatants may have had PTSD.[165]

The researchers from the Grady Trauma Project highlight the tendency people have to focus on the combat side of PTSD: “less public awareness has focused on civilian PTSD, which results from trauma exposure that is not combat related… “ and “much of the research on civilian PTSD has focused on the sequelae of a single, disastrous event, such as the Oklahoma City bombing, September 11th attacks, and Hurricane Katrina”.[166] Disparity in the focus of PTSD research affects the already popular perception of the exclusive interconnectedness of combat and PTSD. This is misleading when it comes to understanding the implications and extent of PTSD as a neurological disorder. Dating back to the definition of Gross stress reaction in the DSM-I, civilian experience of catastrophic or high stress events is included as a cause of PTSD in medical literature. The 2014 National Comorbidity Survey reports that “the traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women.”[167] Because of the initial overt focus on PTSD as a combat related disorder when it was first fleshed out in the years following the war in Vietnam, in 1975 Ann Wolbert Burgess and Lynda Lytle Holmstrom defined Rape trauma syndrome, RTS, in order to draw attention to the striking similarities between the experiences of soldiers returning from war and of rape victims.[168] This paved the way for a more comprehensive understanding of causes of PTSD.

Terminology

The Diagnostic and Statistical Manual of Mental Disorders does not hyphenate ‘post’ and ‘traumatic’, thus, the DSM-5 lists the disorder as posttraumatic stress disorder. However, many scientific journal articles and other scholarly publications do hyphenate the name of the disorder, viz., post-traumatic stress disorder.[169] Dictionaries also differ with regard to the preferred spelling of the disorder with the Collins English Dictionary – Complete and Unabridged using the hyphenated spelling, and the American Heritage Dictionary of the English Language, Fifth Edition and the Random House Kernerman Webster’s College Dictionary giving the non-hyphenated spelling.[170]

Research

To recapitulate some of the neurological and neurobehavioral symptoms experienced by the veteran population of recent conflicts in Iraq and Afghanistan, researchers at the Roskamp Institute and the James A Haley Veteran’s Hospital (Tampa) have developed an animal model to study the consequences of mild traumatic brain injury (mTBI) and PTSD.[171] In the laboratory, the researchers exposed mice to a repeated session of unpredictable stressor (i.e. predator odor while restrained), and physical trauma in the form of inescapable foot-shock, and this was also combined with a mTBI. In this study, PTSD animals demonstrated recall of traumatic memories, anxiety, and an impaired social behavior, while animals subject to both mTBI and PTSD had a pattern of disinhibitory-like behavior. mTBI abrogated both contextual fear and impairments in social behavior seen in PTSD animals. In comparison with other animal studies,[171][172] examination of neuroendocrine and neuroimmune responses in plasma revealed a trend toward increase in corticosterone in PTSD and combination groups.

Psychotherapy adjuncts

MDMA was used for psychedelic therapy for a variety of indications before its criminalization in the US in 1985. In response to its criminalization, the Multidisciplinary Association for Psychedelic Studies was founded as a nonprofit drug-development organization to develop MDMA into a legal prescription drug for use as an adjunct in psychotherapy.[173] The drug is hypothesized to facilitate psychotherapy by reducing fear, thereby allowing patients to reprocess and accept their traumatic memories without becoming emotionally overwhelmed. In this treatment, patients participate in an extended psychotherapy session during the acute activity of the drug, and then spend the night at the treatment facility. In the sessions with the drug, therapists are not directive and support the patients in exploring their inner experiences. Patients participate in standard psychotherapy sessions before the drug-assisted sessions, as well as after the drug-assisted psychotherapy to help them integrate their experiences with the drug.[174] Preliminary results suggest MDMA-assisted psychotherapy might be effective for individuals who have not responded favorably to other treatments. Future research employing larger sample sizes and an appropriate placebo condition, i.e., one in which subjects cannot discern if they are in the experimental or control condition, will increase confidence in the results of initial research.[175][176]

Clinical research is also investigating using D-cycloserine, hydrocortisone, and propranolol as adjuncts to more conventional exposure therapy

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See Shell Shock – The Trauma of Battle

Combat Stress is here to support you

In the UK, there are various charities and service organisations dedicated to aiding veterans in readjusting to civilian life. The Royal British Legion and the more recently established Help for Heroes are two of Britain’s more high-profile veterans’ organisations which have actively advocated for veterans over the years. There has been some controversy that the NHS has not done enough in tackling mental health issues and is instead “dumping” veterans on charities such as Combat Stress.

Visit the website: www.combatstress.org.uk/veterans

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Western Front 1914 – Christmas Truce – 1914.

The Christmas Truce

The Christmas truce (German: Weihnachtsfrieden; French: Trêve de Noël) was a series of widespread but unofficial ceasefires along the Western Front around Christmas 1914. In the week leading up to the holiday, German and British soldiers crossed trenches to exchange seasonal greetings and talk. In areas, men from both sides ventured into no man’s land on Christmas Eve and Christmas Day to mingle and exchange food and souvenirs. There were joint burial ceremonies and prisoner swaps, while several meetings ended in carol-singing.

Men played games of football with one another, giving one of the most enduring images of the truce. However, the peaceful behaviour was not ubiquitous; fighting continued in some sectors, while in others the sides settled on little more than arrangements to recover bodies.

christmas-truce-football

The following year, a few units arranged ceasefires, but the truces were not nearly as widespread as in 1914; this was, in part, due to strongly worded orders from the high commands of both sides prohibiting fraternisation. Soldiers were no longer amenable to truce by 1916. The war had become increasingly bitter after devastating human losses suffered during the battles of the Somme and Verdun, and the incorporation of poison gas.

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The Christmas Truce of 1914

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The truces were not unique to the Christmas period, and reflected a growing mood of “live and let live“, where infantry in close proximity would stop overtly aggressive behaviour, and often engage in small-scale fraternisation, engaging in conversation or bartering for cigarettes. In some sectors, there would be occasional ceasefires to allow soldiers to go between the lines and recover wounded or dead comrades, while in others, there would be a tacit agreement not to shoot while men rested, exercised, or worked in full view of the enemy.

The Christmas truces were particularly significant due to the number of men involved and the level of their participation – even in very peaceful sectors, dozens of men openly congregating in daylight was remarkable – and are often seen as a symbolic moment of peace and humanity amidst one of the most violent events of human history.

 

Background

The first five months of World War I had seen an initial German attack through Belgium into France, which had been repulsed outside Paris by French and British troops at the Battle of the Marne in early September 1914. The Germans fell back to the Aisne valley, where they prepared defensive positions. In the subsequent Battle of the Aisne, the Allied forces were unable to push through the German line, and the fighting quickly degenerated into a stalemate; neither side was willing to give ground, and both started to develop fortified systems of trenches.

To the north, on the right of the German army, there had been no defined front line, and both sides quickly began to try to use this gap to outflank one another; in the ensuing “Race to the Sea“, the two sides repeatedly clashed, each trying to push forward and threaten the end of the other’s line. After several months of fighting, during which the British forces were withdrawn from the Aisne and sent north into Flanders, the northern flank had developed into a similar stalemate. By November, there was a continuous front line running from the North Sea to the Swiss frontier, occupied on both sides by armies in prepared defensive positions.[1]

Christmas Cheer

 Soldiers of the 5th London Rifle Brigade with German Saxon regimental troops during the truce at Ploegsteert

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The Great War: Christmas Truce (WWI Documentary)

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Fraternisation

Fraternisation – peaceful and sometimes friendly interactions between opposing forces – was a regular feature in quiet front-line sectors of the Western Front. In some areas, it manifested simply as a passive inactivity, where both sides would refrain from overtly aggressive or threatening behaviour, while in other cases it extended to regular conversation or even visits from one trench to another.

Truces between British and German units can be dated to early November 1914, around the time opposing armies had begun static trench warfare. At this time, both sides’ rations were brought up to the front line after dusk, and soldiers on both sides noted a period of peace while they collected their food.  By 1 December, a British soldier could record a friendly visit from a German sergeant one morning:

“to see how we were getting on”.

Relations between French and German units were generally more tense, but the same phenomenon began to emerge. In early December, a German surgeon recorded a regular half-hourly truce each evening to recover dead soldiers for burial, during which French and German soldiers exchanged newspapers.

This behaviour was often challenged by both junior and senior officers; the young Charles de Gaulle wrote on 7 December of the “lamentable” desire of French infantrymen to leave the enemy in peace, while the commander of 10th Army, Victor d’Urbal, wrote of the

“unfortunate consequences” when men “become familiar with their neighbours opposite”.

Other truces could be enforced on both sides by weather conditions, especially when trench lines flooded in low-lying areas, though these often lasted after the weather had cleared.

The close proximity of trench lines made it easy for soldiers to shout greetings to each other, and this may have been the most common method of arranging informal truces during 1914. Men would frequently exchange news or greetings, helped by a common language; many German soldiers had lived in England, particularly London, and were familiar with the language and the culture. Several British soldiers recorded instances of Germans asking about news from the football leagues, while other conversations could be as banal as discussions of the weather or as plaintive as messages for a sweetheart.

One unusual phenomenon that grew in intensity was music; in peaceful sectors, it was not uncommon for units to sing in the evenings, sometimes deliberately with an eye towards entertaining or gently taunting their opposite numbers. This shaded gently into more festive activity; in early December, E.H.W. Hulse of the Scots Guards wrote that he was planning to organise a concert party for Christmas Day, which would “give the enemy every conceivable form of song in harmony” in response to frequent choruses of Deutschland Über Alles.

Approach to Christmas

In the lead up to Christmas 1914, there were several peace initiatives. The Open Christmas Letter was a public message for peace addressed “To the Women of Germany and Austria“, signed by a group of 101 British women suffragettes at the end of 1914 as the first Christmas of World War I approached.

Benedictus XV.jpg

Pope Benedict XV, on 7 December 1914, had begged for an official truce between the warring governments.

“He asked that the guns may fall silent at least upon the night the angels sang.”

This attempt was officially rebuffed.

Christmas 1914

British and German troops meeting in no man’s land during the unofficial truce (British troops from the Northumberland Hussars, 7th Division, Bridoux-Rouge Banc Sector)

Roughly 100,000 British and German troops were involved in the unofficial cessations of hostility along the Western Front.

The first truce started on Christmas Eve 1914, when German troops decorated the area around their trenches in the region of Ypres, Belgium and particularly in Saint-Yvon (called Saint-Yves, in Plugstreet/Ploegstraat – Comines-Warneton), where Capt. Bruce Bairnsfather described the truce.

The Germans placed candles on their trenches and on Christmas trees, then continued the celebration by singing Christmas carols. The British responded by singing carols of their own. The two sides continued by shouting Christmas greetings to each other. Soon thereafter, there were excursions across No Man’s Land, where small gifts were exchanged, such as food, tobacco and alcohol, and souvenirs such as buttons and hats.

The artillery in the region fell silent. The truce also allowed a breathing spell where recently killed soldiers could be brought back behind their lines by burial parties. Joint services were held. In many sectors, the truce lasted through Christmas night, continuing until New Year’s Day in others.

 

LtGen W N Congreve.jpg

On the day itself, Brigadier-General Walter Congreve, then commanding 18 Infantry Brigade, stationed near Neuve Chapelle, wrote a letter recalling the Germans initiated by calling a truce for the day. One of his brigade’s men bravely lifted his head above the parapet and others from both sides walked onto no man’s land. Officers and men shook hands and exchanged cigarettes and cigars, one of his Captains

“smoked a cigar with the best shot in the German army”,

the latter no more than 18 years old. Congreve admitted he was reluctant to personally witness the scene of the truce for fear he would be a prime target for German snipers.

Bruce Bairnsfather, who served throughout the war, wrote:

I wouldn’t have missed that unique and weird Christmas Day for anything. … I spotted a German officer, some sort of lieutenant I should think, and being a bit of a collector, I intimated to him that I had taken a fancy to some of his buttons. … I brought out my wire clippers and, with a few deft snips, removed a couple of his buttons and put them in my pocket. I then gave him two of mine in exchange. … The last I saw was one of my machine gunners, who was a bit of an amateur hairdresser in civil life, cutting the unnaturally long hair of a docile Boche, who was patiently kneeling on the ground whilst the automatic clippers crept up the back of his neck.

Future nature writer Henry Williamson, then a nineteen-year-old private in the London Rifle Brigade, wrote to his mother on Boxing Day:

“Dear Mother, I am writing from the trenches. It is 11 o’clock in the morning. Beside me is a coke fire, opposite me a ‘dug-out’ (wet) with straw in it. The ground is sloppy in the actual trench, but frozen elsewhere. In my mouth is a pipe presented by the Princess Mary. In the pipe is tobacco. Of course, you say. But wait. In the pipe is German tobacco. Haha, you say, from a prisoner or found in a captured trench. Oh dear, no! From a German soldier. Yes a live German soldier from his own trench. Yesterday the British & Germans met & shook hands in the Ground between the trenches, & exchanged souvenirs, & shook hands. Yes, all day Xmas day, & as I write. Marvellous, isn’t it?”

Captain Sir Edward Hulse reported how the first interpreter he met from the German lines was from Suffolk where he had left his girlfriend and a 3.5 hp motorcycle. Hulse went on to describe a sing-song which

“ended up with ‘Auld lang syne‘ which we all, English, Scots, Irish, Prussians, Wurttenbergers, etc, joined in. It was absolutely astounding, and if I had seen it on a cinematograph film I should have sworn that it was faked!”

Captain Robert Patrick Miles, King’s Shropshire Light Infantry, who was attached to the Royal Irish Rifles recalled in an edited letter that was published in both the Daily Mail and the Wellington Journal & Shrewsbury News in January 1915, following his death in action on 30 December 1914:

Friday (Christmas Day). We are having the most extraordinary Christmas Day imaginable. A sort of unarranged and quite unauthorized but perfectly understood and scrupulously observed truce exists between us and our friends in front. The funny thing is it only seems to exist in this part of the battle line – on our right and left we can all hear them firing away as cheerfully as ever.

The thing started last night – a bitter cold night, with white frost – soon after dusk when the Germans started shouting ‘Merry Christmas, Englishmen’ to us. Of course our fellows shouted back and presently large numbers of both sides had left their trenches, unarmed, and met in the debatable, shot-riddled, no man’s land between the lines. Here the agreement – all on their own – came to be made that we should not fire at each other until after midnight tonight.

The men were all fraternizing in the middle (we naturally did not allow them too close to our line) and swapped cigarettes and lies in the utmost good fellowship. Not a shot was fired all night.

Of the Germans he wrote:

“They are distinctly bored with the war…In fact, one of them wanted to know what on earth we were doing here fighting them.” The truce in that sector continued into Boxing Day; he commented about the Germans, “The beggars simply disregard all our warnings to get down from off their parapet, so things are at a deadlock. We can’t shoot them in cold blood…I cannot see how we can get them to return to business.”

On Christmas Eve and Christmas Day (24 and 25 December) 1914, Alfred Anderson’s unit of the 1st/5th Battalion of Black Watch was billeted in a farmhouse away from the front line. In a later interview (2003), Anderson, the last known surviving Scottish veteran of the war, vividly recalled Christmas Day and said:

I remember the silence, the eerie sound of silence. Only the guards were on duty. We all went outside the farm buildings and just stood listening. And, of course, thinking of people back home. All I’d heard for two months in the trenches was the hissing, cracking and whining of bullets in flight, machinegun fire and distant German voices. But there was a dead silence that morning, right across the land as far as you could see. We shouted ‘Merry Christmas’, even though nobody felt merry. The silence ended early in the afternoon and the killing started again. It was a short peace in a terrible war.

Nor were the observations confined to the British. French Leutnant Johannes Niemann wrote:

“grabbed my binoculars and looking cautiously over the parapet saw the incredible sight of our soldiers exchanging cigarettes, schnapps and chocolate with the enemy.”

General Sir Horace Smith-Dorrien, commander of the British II Corps, issued orders forbidding friendly communication with the opposing German troops.  Adolf Hitler, then a young corporal of the 16th Bavarian Reserve Infantry, was also an opponent of the truce.

In the Comines sector of the front there was an early fraternisation between German and French soldiers in December 1914, during a short truce, and there are at least two other testimonials, from French soldiers, of similar behaviours in sectors where German and French companies opposed each other. Gervais Morillon wrote to his parents: ‘The Boches waved a white flag and shouted “Kamarades, Kamarades, rendez-vous.”

When we didn’t move they came towards us unarmed, led by an officer. Although we are not clean they are disgustingly filthy. I am telling you this but don’t speak of it to anyone. We must not mention it even to other soldiers.’ Gustave Berthier wrote: ‘On Christmas day the Boches made a sign showing they wished to speak to us. They said they didn’t want to shoot … They were tired of making war, they were married like me, they didn’t have any differences with the French but with the English.’

In sections of the front where German and Belgian troops faced each other in December 1914, there was at least one such instance when a truce was achieved at the request of Belgian soldiers who wished to send letters back to their families, over the German-occupied parts of their own country.[28]

Richard Schirrmann, who was in a German regiment holding a position on the Bernhardstein, one of the mountains of the Vosges, wrote an account of events in December 1915: “When the Christmas bells sounded in the villages of the Vosges behind the lines ….. something fantastically unmilitary occurred. German and French troops spontaneously made peace and ceased hostilities; they visited each other through disused trench tunnels, and exchanged wine, cognac and cigarettes for Westphalian black bread, biscuits and ham. This suited them so well that they remained good friends even after Christmas was over.” He was separated from the French troops by a narrow No Man’s Land and described the landscape as: “Strewn with shattered trees, the ground ploughed up by shellfire, a wilderness of earth, tree-roots and tattered uniforms.” Military discipline was soon restored, but Schirrmann pondered over the incident, and whether “thoughtful young people of all countries could be provided with suitable meeting places where they could get to know each other.” He went on to found the German Youth Hostel Association in 1919.[29]

Football Matches

Many accounts of the truce involve one or more football matches played in no-man’s land. This was mentioned in some of the earliest reports, with a letter written by a doctor attached to the Rifle Brigade, published in The Times on 1 January 1915, reported

“a football match… played between them and us in front of the trench.”

A wide range of similar stories have been told over the years, often naming specific units or a precise score. Some accounts of the game bring in elements of fiction by Robert Graves, a British poet and writer who reconstructed the encounter in a story published in 1962; in Graves’s version, the score was 3–2 to the Germans.

However, the truth of the accounts has been disputed by some historians; in 1984, Malcolm Brown and Shirley Seaton concluded that there were probably attempts to play organised matches which failed due to the state of the ground, but that the contemporary reports were either hearsay or refer to ‘kick-about’ matches with ‘made-up footballs’ such as a bully-beef tin.

Chris Baker, former chairman of The Western Front Association and author of The Truce: The Day the War Stopped is also skeptical, but says that although there is little hard evidence, the most likely place that an organised match could have taken place was near the village of Messines:

“There are two references to a game being played on the British side, but nothing from the Germans. If somebody one day found a letter from a German soldier who was in that area, then we would have something credible.”

In fact, there is a German reference. Leutnant Kurt Zehmisch of Germany’s 134th Saxons Infantry Regiment said that the English “brought a soccer ball from their trenches, and pretty soon a lively game ensued. How marvelously wonderful, yet how strange it was.”[34] In 2011, Mike Dash concluded that

“there is plenty of evidence that football was played that Christmas Day—mostly by men of the same nationality, but in at least three or four places between troops from the opposing armies”.

 

A wide variety of units were reported in contemporary accounts to have taken part in games; Dash listed the 133rd Royal Saxon Regiment pitched against “Scottish troops”; the Argyll and Sutherland Highlanders against unidentified Germans (with the Scots reported to have won 4–1); the Royal Field Artillery against “Prussians and Hanovers” near Ypres; and the Lancashire Fusiliers, based near Le Touquet, with the specific detail of a bully beef ration tin as the “ball”.One recent writer has identified 29 separate reports of football, though does not give substantive details.

Eastern Front

A separate manifestation of the Christmas truce in December 1914 occurred on the Eastern front, where the first move originated from the Austrian commanders, at some uncertain level of the military hierarchy. The Russians responded positively and soldiers eventually met in no man’s land.

Public Awareness

The events of the truce were not reported for a week, in an unofficial press embargo which was eventually broken by the New York Times on 31 December. The British papers quickly followed, printing numerous first-hand accounts from soldiers in the field, taken from letters home to their families, and editorials on “one of the greatest surprises of a surprising war”. By 8 January pictures had made their way to the press, and both the Mirror and Sketch printed front-page photographs of British and German troops mingling and singing between the lines. The tone of the reporting was strongly positive, with the Times endorsing the “lack of malice” felt by both sides and the Mirror regretting that the “absurdity and the tragedy” would begin again.

Coverage in Germany was more muted, with some newspapers strongly criticising those who had taken part, and no pictures published. In France, meanwhile, the greater level of press censorship ensured that the only word that spread of the truce came from soldiers at the front or first-hand accounts told by wounded men in hospitals.

The press was eventually forced to respond to the growing rumours by reprinting a government notice that fraternising with the enemy constituted treason, and in early January an official statement on the truce was published, claiming it had happened on restricted sectors of the British front, and amounted to little more than an exchange of songs which quickly degenerated into shooting.

Later Truces

After Christmas 1914, sporadic attempts were made at seasonal truces; a German unit attempted to leave their trenches under a flag of truce on Easter Sunday 1915, but were warned off by the British opposite them, and later in the year, in November, a Saxon unit briefly fraternised with a Liverpool battalion. In December 1915, there were explicit orders by the Allied commanders to forestall any repeat of the previous Christmas truce. Individual units were encouraged to mount raids and harass the enemy line, whilst communicating with the enemy was discouraged by artillery barrages along the front line throughout the day. The prohibition was not completely effective, however, and a small number of brief truces occurred.

An eyewitness account of one truce, by Llewelyn Wyn Griffith, recorded that after a night of exchanging carols, dawn on Christmas Day saw a “rush of men from both sides … [and] a feverish exchange of souvenirs” before the men were quickly called back by their officers, with offers to hold a ceasefire for the day and to play a football match. It came to nothing, as the brigade commander threatened repercussions for the lack of discipline, and insisted on a resumption of firing in the afternoon. Another member of Griffith’s battalion, Bertie Felstead, later recalled that one man had produced a football, resulting in “a free-for-all; there could have been 50 on each side”, before they were ordered back.[42]

In an adjacent sector, a short truce to bury the dead between the lines led to official repercussions; a company commander, Sir Iain Colquhoun of the Scots Guards, was court-martialled for defying standing orders to the contrary. While he was found guilty and reprimanded, the punishment was annulled by General Haig and Colquhoun remained in his position; the official leniency may perhaps have been because he was related to H. H. Asquith, the Prime Minister.

In the Decembers of 1916 and 1917, German overtures to the British for truces were recorded without any success. In some French sectors, singing and an exchange of thrown gifts was occasionally recorded, though these may simply have reflected a seasonal extension of the live-and-let-live approach common in the trenches.

At Easter 1915 there were recorded instances of truces between Orthodox troops of opposing sides on the Eastern front. The Bulgarian writer Yordan Yovkov, serving as an officer near the Greek border at the Mesta river, witnessed one such truce. It inspired his short story ‘Holy Night’, translated into English in 2013 by Krastu Banaev.

Legacy and historical significance

 

Although the popular tendency has been to see the December 1914 Christmas Truces as unique and therefore of romantic rather than political significance, they have also been interpreted as part of the widespread non-cooperation with the war spirit and conduct by serving soldiers.

In his book on trench warfare, historian Tony Ashworth describes what he calls the ‘live and let live system.’ Complicated local truces and agreements not to fire at each other were developed by men along the front throughout the war. These often began with agreement not to attack each other at tea, meal or washing times, and in some places became so developed that whole sections of the front would see few casualties for extended periods of time. This system, Ashworth argues, ‘gave soldiers some control over the conditions of their existence.’

The December 1914 Christmas Truces then can be seen as not unique, but as the most dramatic example of non-cooperation with the war spirit that included refusal to fight, unofficial truces, mutinies, strikes, and peace protests.

  • In the 1933 play Petermann schließt Frieden oder Das Gleichnis vom deutschen Opfer (Petermann makes peace: or, the parable of German sacrifice), written by Nazi writer and World War I veteran Heinz Steguweit (German), a German soldier, accompanied by Christmas carols sung by his comrades, erects an illuminated Christmas tree between the trenches, but is shot dead by the enemy. Later, when the fellow soldiers find his body, they notice in horror that enemy snipers have shot down every single Christmas light from the tree.[49]
  • The 1967 song “Snoopy’s Christmas” by the Royal Guardsmen was based on the Christmas truce.
  • The 1969 film Oh! What a Lovely War includes a scene of a Christmas truce with British and German soldiers sharing jokes, alcohol and songs.
  • The video for the 1983 song “Pipes of Peace” by Paul McCartney depicts a fictionalized version of the Christmas truce.[50]
  • The final episode of the BBC television series Blackadder Goes Forth references the Christmas truce, with the main character Edmund Blackadder having played in a football match. He is also seen being annoyed at having had a goal disallowed for offside.[51]
  • The song “All Together Now” by Liverpool band The Farm took its inspiration from the Christmas Day Truce of 1914. The song has been re-recorded by The Peace Collective for release in December 2014 to mark the centenary of the event.[52]
  • John McCutcheon‘s song “Christmas in the Trenches,” from his 1984 album Winter Solstice, presents a composite account of attested events of the truce from the perspective of a fictitious English soldier. (Mike Harding‘s song “Christmas 1914”, from his 1989 album Plutonium Alley, and Garth Brooks‘s song “Belleau Wood”, from his 1997 album Sevens, contain similar depictions of the truce.)
  • The 1992 film A Midnight Clear depicts a Christmas truce loosely based on events from the 1914 truce, although the setting is moved to the end of WWII.[53]
  • In the intro of the 1995 episode “The River of Stars” of the series Space: Above and Beyond images of the Christmas Truce of 1914 were shown.
  • The truce is dramatized in the 2005 French film Joyeux Noël (English: Merry Christmas), depicted through the eyes of French, British and German soldiers.[54] The film, written and directed by Christian Carion,[55] was screened out of competition at the 2005 Cannes Film Festival.[56]
  • In 2008, the truce was depicted on stage at the Pantages Theater in Minneapolis, in the radio musical drama All Is Calm: The Christmas Truce of 1914. It was created and directed by Peter Rothstein, and co-produced by Theater Latté Da and the vocal ensemble Cantus, both Minneapolis-based organizations. It has continued to play at the Pantages Theater each December since its premiere.
  • Ahead of the centenary of the truce (December 2014), English composer Chris Eaton and singer Abby Scott produced the song, 1914 – The Carol of Christmas, to benefit British armed forces charities. At 5 December 2014 it had reached top of the iTunes Christmas chart.[57]
  • In 2014 the Northumbria and Newcastle Universities Martin Luther King Peace Committee[58] produced resources to enable schools and churches to mark the December 1914 Christmas Truces. These included lesson plans, hand-outs, worksheets, PowerPoint slide shows, and full plans for assemblies, and carol services/Christmas productions. The authors explained that their purpose was both to enable schoolteachers to help children learn about the remarkable events of December 1914, but also to use the theme of Christmas to provide a counterpoint to the UK government’s glorification of the First World War as heroic. As the Peace Committee argues, “These spontaneous acts of festive goodwill directly contradicted orders from high command, and offered an evocative and hopeful – albeit brief – recognition of shared humanity”[59] – and thereby, they argue, give a rereading of the traditional Christmas message of “on earth peace, good will toward men.”[60]

Monuments

A Christmas truce memorial was unveiled in Frelinghien, France, on 11 November 2008. Also on that day, at the spot where, on Christmas Day 1914, their regimental ancestors came out from their trenches to play football, men from the 1st Battalion, The Royal Welch Fusiliers played a football match with the German Battalion 371. The Germans won 2–1.

On 12 December 2014, a memorial was unveiled at the National Memorial Arboretum in Staffordshire, England by Prince William, Duke of Cambridge and the England national football team manager Roy Hodgson.The Football Remembers memorial was designed by ten-year-old schoolboy Spencer Turner after a UK-wide competition

War Remembrance Day Poppy – Wear it with PRIDE. In Flanders fields the poppies blow…….

Remembrance Day Poppy 

pumpkin soildier

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In Flanders Fields

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Wear it with PRIDE

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John McCrae’s War – In Flanders Fields – Documentary

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John McCrae

John McCrae

“In Flanders Fields” is a war poem in the form of a rondeau, written during the First World War by Canadian physician Major John McCrae. He was inspired to write it on May 3, 1915, after presiding over the funeral of friend and fellow soldier Alexis Helmer, who died in the Second Battle of Ypres.

According to legend, fellow soldiers retrieved the poem after McCrae, initially dissatisfied with his work, discarded it. “In Flanders Fields” was first published on December 8 of that year in the London-based magazine Punch.

A sculpture in the form of an open book. The text of the poem
Inscription of the complete poem in a bronze “book” at the John McCrae memorial at his birthplace in Guelph, Ontario, Canada.

Inscription of the complete poem in a bronze “book” at the John McCrae memorial at his birthplace in Guelph, Ontario, Canada.

 

It is one of the most popular and most quoted poems from the war. As a result of its immediate popularity, parts of the poem were used in propaganda efforts and appeals to recruit soldiers and raise money selling war bonds. Its references to the red poppies that grew over the graves of fallen soldiers resulted in the remembrance poppy becoming one of the world’s most recognized memorial symbols for soldiers who have died in conflict. The poem and poppy are prominent Remembrance Day symbols throughout the Commonwealth of Nations, particularly in Canada, where “In Flanders Fields” is one of the nation’s best-known literary works. The poem also has wide exposure in the United States, where it is associated with Memorial Day.

Backgound

John McCrae was a poet and physician from Guelph, Ontario. He developed an interest in poetry at a young age and wrote throughout his life.  His earliest works were published in the mid-1890s in Canadian magazines and newspapers. McCrae’s poetry often focused on death and the peace that followed.

At the age of 41, McCrae enrolled with the Canadian Expeditionary Force following the outbreak of the First World War. He had the option of joining the medical corps because of his training and age, but he volunteered instead to join a fighting unit as a gunner and medical officer.

It was his second tour of duty in the Canadian military. He had previously fought with a volunteer force in the Second Boer War. He considered himself a soldier first; his father was a military leader in Guelph and McCrae grew up believing in the duty of fighting for his country and empire.

McCrae fought in the second battle of Ypres in the Flanders region of Belgium where the German army launched one of the first chemical attacks in the history of war. They attacked the Canadian position with chlorine gas on April 22, 1915, but were unable to break through the Canadian line, which held for over two weeks. In a letter written to his mother, McCrae described the battle as a “nightmare”:

“For seventeen days and seventeen nights none of us have had our clothes off, nor our boots even, except occasionally. In all that time while I was awake, gunfire and rifle fire never ceased for sixty seconds…. And behind it all was the constant background of the sights of the dead, the wounded, the maimed, and a terrible anxiety lest the line should give way.”

 

Alexis Helmer, a close friend, was killed during the battle on May 2. McCrae performed the burial service himself, at which time he noted how poppies quickly grew around the graves of those who died at Ypres. The next day, he composed the poem while sitting in the back of an ambulance at an Advanced Dressing Station outside Ypres.

This location is today known as the John McCrae Memorial Site.

 

The poem handwritten by McCrae. In this copy, the first line ends with

An autographed copy of the poem from In Flanders Fields and Other Poems. Unlike the printed copy in the same book, McCrae’s handwritten version ends the first line with “grow”.

 

The first chapter of In Flanders Fields and Other Poems, a 1919 collection of McCrae’s works, gives the text of the poem as follows:

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

 

As with his earlier poems, “In Flanders Fields” continues McCrae’s preoccupation with death and how it stands as the transition between the struggle of life and the peace that follows.  It is written from the point of view of the dead. It speaks of their sacrifice and serves as their command to the living to press on.

As with many of the most popular works of the First World War, it was written early in the conflict, before the romanticism of war turned to bitterness and disillusion for soldiers and civilians alike.

Publication

A page from a book. The first stanza of the poem is printed above an illustration of a white cross amidst a field of red poppies while two cannons fire in the background.

Illustrated page by Ernest Clegg. Note that the first line ends with “grow”.

 

Cyril Allinson was a sergeant major in McCrae’s unit. While delivering the brigade’s mail, he watched McCrae as he worked on the poem, noting that McCrae’s eyes periodically returned to Helmer’s grave as he wrote. When handed the notepad, Allinson read the poem and was so moved he immediately committed it to memory.

He described it as being “almost an exact description of the scene in front of us both”.

According to legend, McCrae was not satisfied with his work. It is said he crumpled the paper and threw it away. It was retrieved by a fellow member of his unit, either Edward Morrison or J. M. Elder, or Allinson himself.  McCrae was convinced to submit the poem for publication.

Another story of the poem’s origin claimed that Helmer’s funeral was actually held on the morning of May 2, after which McCrae wrote the poem in 20 minutes. A third claim, by Morrison, was that McCrae worked on the poem as time allowed between arrivals of wounded soldiers in need of medical attention.

Regardless of its true origin, McCrae worked on the poem for months before considering it ready for publication. He submitted it to The Spectator in London, but it was rejected. It was then sent to Punch, where it was published on December 8, 1915. It was published anonymously, but Punch attributed the poem to McCrae in its year-end index.

The word that ends the first line of the poem has been disputed. According to Allinson, the poem began with “In Flanders Fields the poppies grow” when first written.

However, since McCrae ended the second-to-last line with “grow”, Punch received permission to change the wording of the opening line to end with “blow”. McCrae himself used either word when making handwritten copies for friends and family.

Questions over how the first line should end have endured since publication. Most recently, the Royal Canadian Mint was inundated with queries and complaints from those who believed the first line should end with “grow” when a design for the ten-dollar bill was released in 2001 that featured the first stanza of “In Flanders Fields”, ending the first line with “blow”.

In song

It was set to music by Frank E. Tours. The score was published in New York and Chicago by M. Witmark & Sons in 1918.

Popularity

Painting of a soldier staring down at a white cross surrounded by red poppies. The text

Aspects of the poem were used in propaganda, such as this Canadian war bonds poster

 

According to historian Paul Fussell, “In Flanders Fields” was the most popular poem of its era. McCrae received numerous letters and telegrams praising his work when he was revealed as the author.

The poem was republished throughout the world, rapidly becoming synonymous with the sacrifice of the soldiers who died in the First World War. It was translated into numerous languages, so many that McCrae himself quipped that:

“it needs only Chinese now, surely”.

Its appeal was nearly universal. Soldiers took encouragement from it as a statement of their duty to those who died while people on the home front viewed it as defining the cause for which their brothers and sons were fighting.

It was often used for propaganda, particularly in Canada by the Unionist Party during the 1917 federal election amidst the Conscription Crisis. French Canadians in Quebec were strongly opposed to the possibility of conscription, but English Canadians voted overwhelmingly to support Prime Minister Robert Borden and the Unionist government. “In Flanders Fields” was said to have done more to “make this Dominion persevere in the duty of fighting for the world’s ultimate peace than all the political speeches of the recent campaign”.

McCrae, a staunch supporter of the empire and the war effort, was pleased with the effect his poem had on the election. He stated in a letter: “I hope I stabbed a [French] Canadian with my vote.”

The poem was a popular motivational tool in Great Britain, where it was used to encourage soldiers fighting against Germany, and in the United States where it was reprinted across the country. It was one of the most quoted works during the war, used in many places as part of campaigns to sell war bonds, during recruiting efforts and to criticize pacifists and those who sought to profit from the war.

American composer Charles Ives used “In Flanders Fields” as the basis for a song of the same name that premiered in 1917. Fussell criticized the poem in his work The Great War and Modern Memory (1975).He noted the distinction between the pastoral tone of the first nine lines and the “recruiting-poster rhetoric” of the third stanza. Describing it as “vicious” and “stupid”, Fussell called the final lines a “propaganda argument against a negotiated peace”.

Legacy

McCrae was moved to the medical corps and stationed in Boulogne, France, in June 1915 where he was promoted to Lieutenant-Colonel, and placed in charge of medicine at the Number 3 Canadian General Hospital.  He was promoted to the acting rank of Colonel on January 13, 1918, and named Consulting Physician to the British Armies in France. The years of war had worn McCrae down, however. He contracted pneumonia that same day, and later came down with cerebral meningitis.

On January 28, 1918, he died at the military hospital in Wimereux and was buried there with full military honours.

A book of his works, featuring “In Flanders Fields” was published the following year.

“In Flanders Fields” has attained iconic status in Canada, where it is a staple of Remembrance Day ceremonies and may be the most well known literary piece among English Canadians.

It has an official French adaptation, entitled “Au champ d’honneur“, written by Jean Pariseau and used by the Canadian government in French and bilingual ceremonies.

In addition to its appearance on the ten-dollar bill, the Royal Canadian Mint has released poppy-themed quarters on several occasions. A version minted in 2004 featured a red poppy in the centre and is considered the first multi-coloured circulation coin in the world.Among its uses in popular culture, the line “to you from failing hands we throw the torch, be yours to hold it high” has served as a motto for the Montreal Canadiens hockey club since 1940.

McCrae’s birthplace in Guelph, Ontario has been converted into a museum dedicated to his life and the war. In Belgium, the In Flanders Fields Museum in Ypres, named after the poem and devoted to the First World War, is situated in one of Flanders’ largest tourist areas.

Despite its enduring fame, “In Flanders Fields” is often ignored by academics teaching and discussing Canadian literature. The poem is sometimes viewed as an anachronism; It spoke of glory and honour in a war that has since become synonymous with the futility of trench warfare and the wholesale slaughter produced by 20th century weaponry.

Nancy Holmes, professor at the University of British Columbia, speculated that its patriotic nature and usage as a tool for propaganda may have led literary critics to view it as a national symbol or anthem rather than a poem.

Remembrance poppies

 

Main article: Remembrance poppy

Several wreaths of artificial red poppies with black centres. The logo of various veterans and community groups are printed in the middle of each.

Poppy wreaths at the Menin Gate in Ypres, Belgium

 

The red poppies that McCrae referred to had been associated with war since the Napoleonic Wars when a writer of that time first noted how the poppies grew over the graves of soldiers. The damage done to the landscape in Flanders during the battle greatly increased the lime content in the surface soil, leaving the poppy as one of the few plants able to grow in the region.

Inspired by “In Flanders Fields”, American professor Moina Michael resolved at the war’s conclusion in 1918 to wear a red poppy year-round to honour the soldiers who had died in the war. She also wrote a poem in response called “We Shall Keep the Faith“.

She distributed silk poppies to her peers and campaigned to have them adopted as an official symbol of remembrance by the American Legion. Madame E. Guérin attended the 1920 convention where the Legion supported Michael’s proposal and was herself inspired to sell poppies in her native France to raise money for the war’s orphans.

In 1921, Guérin sent poppy sellers to London ahead of Armistice Day, attracting the attention of Field Marshal Douglas Haig. A co-founder of The Royal British Legion, Haig supported and encouraged the sale. The practice quickly spread throughout the British Empire. The wearing of poppies in the days leading up to Remembrance Day remains popular in many areas of the Commonwealth of Nations, particularly Great Britain, Canada, and South Africa, and in the days leading up to ANZAC Day in Australia and New Zealand.

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The Remembrance Poppy

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The remembrance poppy (a Papaver rhoeas) has been used since 1921 to commemorate soldiers who have died in war. Inspired by the World War I poem “In Flanders Fields“, and promoted by Moina Michael, they were first adopted by the American Legion to commemorate American soldiers killed in that war (1914–1918). They were then adopted by military veterans‘ groups in parts of the former British Empire: the United Kingdom, Canada, Australia and New Zealand.

Today, they are most common in the UK and Canada, and are used to commemorate their servicemen and women killed in all conflicts since 1914. There, small artificial poppies are often worn on clothing for a few weeks prior to Remembrance Day/Armistice Day (11 November).

Poppy wreaths are also often laid at war memorials.

The remembrance poppy is especially prominent in the UK. In the weeks leading up to Remembrance Sunday, they are distributed by The Royal British Legion in return for donations to their “Poppy Appeal”, which supports all current and former British military personnel. During this time, it is an unwritten rule that all public figures and people appearing on television must wear them; some have berated this as “poppy fascism” and argued that the Appeal is being used to glorify current wars.

It is especially controversial in Northern Ireland; most Irish nationalists and Irish Catholics refuse to wear one, mainly due to actions of the British Army during the Troubles, while Ulster Protestants and Unionists usually wear them.

Origins

The use of the poppy was inspired by the World War I poem “In Flanders Fields“. Its opening lines refer to the many poppies that were the first flowers to grow in the churned-up earth of soldiers’ graves in Flanders, a region of Europe that overlies a part of Belgium.

The poem was written by Canadian physician and Lieutenant Colonel John McCrae on 3 May 1915 after witnessing the death of his friend, a fellow soldier, the day before. The poem was first published on 8 December 1915 in the London-based magazine Punch.

Moina Michael on a 1948 U.S. commemorative stamp

 

In 1918, Moina Michael, who had taken leave from her professorship at the University of Georgia to be a volunteer worker for the American YWCA, was inspired by the poem and published a poem of her own called “We Shall Keep the Faith“.

In tribute to McCrae’s poem, she vowed to always wear a red rememberance poppy as a symbol of remembrance for those who fought and helped in the war. At a November 1918 YWCA Overseas War Secretaries’ conference, she appeared with a silk poppy pinned to her coat and distributed 25 more to those attending. She then campaigned to have the poppy adopted as a national symbol of remembrance.

At a conference in 1920, the National American Legion adopted it as their official symbol of remembrance. At this conference, French-woman Anna E. Guérin was inspired to introduce the artificial poppies commonly used today. In 1921 she sent her poppy sellers to London, where they were adopted by Field Marshal Douglas Haig, a founder of the Royal British Legion. It was also adopted by veterans’ groups in Canada, Australia and New Zealand.

Usage

Canada

In Canada, the poppy is the official symbol of remembrance worn during the two weeks before 11 November, having been adopted in 1921. The Royal Canadian Legion, which has trademarked the image, suggests that poppies be worn on the left lapel, or as near the heart as possible.

Until 1996, poppies were made by disabled veterans in Canada, but they have since been made by a private contractor. The Canadian poppies consist of two pieces of moulded plastic covered with flocking with a pin to fasten them to clothing. At first the poppies were made with a black centre. From 1980 to 2002, the centres were changed to green. Current designs are black only; this change caused confusion and controversy to those unfamiliar with the original design.

In 2007, sticker versions of the poppy were made for children, the elderly, and healthcare and food industry workers. Canada also issues a cast metal “Canada Remembers” pin featuring a gold maple leaf and two poppies, one representing the fallen and the other representing those who remained on the home front.

Following the installation of the Tomb of the Unknown Soldier at the National War Memorial in Ottawa in 2000, where the national Remembrance service is held, a new tradition formed spontaneously as attendees laid their poppies on the tomb at the end of the service. This tradition, while not part of the official program, has become widely practised elsewhere in the country, with others leaving cut flowers, photographs, or letters to the deceased.

The poppy is also worn on Memorial Day, celebrated on July 1 each year in Newfoundland and Labrador.

United Kingdom

Royal British Legion poppy

 

A volunteer makes poppies at the Royal British Legion Poppy Factory in London, where over 30 million poppies are made by a small team each year

 

A poppy on a bus in Southampton, England (November 2008)

 

In the United Kingdom, remembrance poppies are sold by The Royal British Legion (RBL). This is a charity providing financial, social, political and emotional support to those who have served or who are currently serving in the British Armed Forces, and their dependants. They are sold on the streets by volunteers in the weeks before Remembrance Day. Other products bearing the Poppy, the Trademark of The Royal British Legion are sold throughout the year as part of the ongoing fundraising.

The RBL state,

“The red poppy is our registered mark and its only lawful use is to raise funds for the Poppy Appeal”;

its yearly fundraising drive in the weeks before Remembrance Day. The RBL says these poppies are:

“worn to commemorate the sacrifices of our Armed Forces and to show support to those still serving today”.

 

In England, Wales, and Northern Ireland, the poppies have two red paper petals, a green paper leaf and are mounted on a green plastic stem. In Scotland, the poppies are curled and have four petals with no leaf. The yearly selling of poppies is a major source of income for the RBL in the UK. The poppy has no fixed price; it is sold for a donation or the price may be suggested by the seller. The black plastic center of the poppy was marked “Haig Fund” until 1994 but is now marked “Poppy Appeal”.

A team of about 50 people—most of them disabled former British military personnel—work all year round to make millions of poppies at the Poppy Factory in Richmond. Scottish poppies are made in the Lady Haig Poppy Factory in Edinburgh.

In the early years after World War I, poppies were worn only on Remembrance Day itself. However, today the RBL’s “Poppy Appeal” has a higher profile than any other charity appeal in the UK. The poppies are widespread from late October until mid-November every year and are worn by the general public, politicians, the Royal Family and others in public life. It has also become common to see poppies on cars, lorries and public transport such as aeroplanes, buses, and trams. Many magazines and newspapers also show a poppy on their cover page, and some social network users add poppies to their avatars.

In 2011, a Second World War plane dropped 6,000 poppies over the town of Yeovil in Somerset.

Some have criticised the level of compulsion associated with the custom, something Channel 4 newsreader Jon Snow has called “poppy fascism”. Columnist Dan O’Neill wrote that “presenters and politicians seem to compete in a race to be first – poppies start sprouting in mid-October while the absence of a poppy is interpreted as absence of concern for the war dead, almost as an unpatriotic act of treachery”.

Likewise, Jonathan Bartley of the religious think-tank Ekklesia said “public figures in Britain are urged, indeed in many cases, required, to wear … the red poppy, almost as an article of faith. There is a political correctness about the red poppy”.

Journalist Robert Fisk complained that the poppy has become a seasonal “fashion accessory” and that people were “ostentatiously wearing a poppy for social or work-related reasons, to look patriotic when it suited them”. Kleshna, one of two businesses with an exclusive tie-in with the RBL, sells expensive crystal-clad poppy jewellery that has been worn by celebrities. In 1997 and again in 2000 the Royal British Legion registered the Poppy under Intellectual Property Rights (1997 Case EU000557058) and Trade Mark (2000 Trade Mark 2239583).

Northern Ireland

The Royal British Legion also holds a yearly poppy appeal in Northern Ireland and in 2009 raised more than £1 million. However, the wearing of poppies in Northern Ireland is controversial. It is seen by many as a political symbol  and a symbol of Britishness, representing support for the British Army.

The poppy has long been the preserve of the unionist/loyalist community.  Loyalist paramilitaries (such as the UVF and UDA) have also used poppies to commemorate their own members who were killed in The Troubles.

Most Irish nationalists/republicans, and members of the Irish Catholic community, choose not to wear poppies;  they regard the Poppy Appeal as supporting soldiers who killed Irish civilians (for example on Bloody Sunday) and who colluded with illegal loyalist paramilitaries (for example the Glenanne gang) during The Troubles.

In 2008, the director of Relatives for Justice condemned the wearing of poppies by police officers in Irish nationalist areas, calling it “repugnant and offensive to the vast majority of people within our community, given the role of the British Army“.

In 2009, Sinn Féin‘s Glenn Campbell berated the policy that all BBC TV presenters must wear poppies in the run-up to Remembrance Day and urged the BBC to drop the policy, as it is a publicly funded body. In the Irish Independent, it was claimed that “substantial amounts” of money raised from selling poppies are used “to build monuments to insane or inane generals or build old boys’ clubs for the war elite”.

However, on Remembrance Day 2010 the SDLP’s Margaret Ritchie was the first leader of a nationalist party to wear one.

Republic of Ireland

During World War I, all of Ireland was part of the UK and about 200,000 Irishmen fought in the British Army (see Ireland and World War I). Although the British Army is banned from actively recruiting in the Republic of Ireland, some of its citizens still enlist.

The RBL thus has a branch in the Republic and holds a yearly Poppy Appeal there.

Each July, the Republic has its own National Day of Commemoration for all Irish people who died in war. However, the wearing of poppies is much less common than in the UK and they are not part of the main commemorations. This is partly due to the British Army’s role in fighting against Irish independence, its activities during the War of Independence (for example the Burning of Cork) and the British Army’s role in Northern Ireland during the Troubles. Nevertheless, the RBL holds its own wreath-laying ceremony at St Patrick’s Cathedral, Dublin, which the President of Ireland has attended.

United States

In the United States, the Veterans of Foreign Wars conducted the first nationwide distribution of remembrance poppies before Memorial Day in 1922. Today, the American Legion Auxiliary distributes crepe-paper poppies in exchange for donations around Memorial Day and Veterans Day.

Elsewhere

In Hong Kong—which was formerly part of the British Empire—the poppy is worn by some participants on Remembrance Sunday each year.  It is not generally worn by the public, although The Royal British Legion’s Hong Kong and China Branch sells poppies to the public in a few places on the Hong Kong Island only.

Never Again symbol from Ukraine

 

During Victory Day 2014—which marks Nazi Germany’s surrender to the Soviet Union—some Ukrainians wore remembrance poppies instead of the usual Ribbon of Saint George, as the ribbon had become associated with pro-Russian separatists. A poppy logo was designed by Sergiy Mishakin, containing the text: “1939-1945 Never Again”.

From 2015 also official symbol of Remembrance and Reconciliation (May 8) and Victory Day over Nazism in World War II (May 9) days.

In Pakistan, in Northern Punjab and a few parts of the North-West Frontier (now Khyber Pakhtunkhwa), a private ceremony is celebrated each 11 November where red poppies are worn, by direct descendants of World War 1 veterans from the old British Indian Army belonging to these parts;  these people belong to the ‘Great War Company’, a non-governmental, non-profit organisation.

In Albania, government representatives including Prime-Minister Edi Rama, Speaker of the House Ilir Meta, and Minister of Defense Mimi Kodheli, wore the Remembrance Poppy during the commemoration ceremonies for the 70th Anniversary of the Liberation of Albania, in November 2014.

Other designs and purposes

White poppies

A white poppy left on Anzac Day in New Zealand, 2009

 

Some people choose to wear white poppies as a pacifist alternative to the red poppy. The white poppy and white poppy wreaths were introduced by Britain’s Co-operative Women’s Guild in 1933.

Today, white poppies are sold by Peace Pledge Union or may be home-made.

Purple poppies

To commemorate animal victims of war, Animal Aid in Britain has issued a purple poppy, which can be worn alongside the traditional red one, as a reminder that both humans and animals have been – and continue to be – victims of war.

Protests and controversy

Football clubs commonly wear jerseys with a poppy emblazoned on, as Celtic controversially did in 2010.

 

In 1993, The Royal British Legion complained about the logo of the game Cannon Fodder, because its use of iconography closely resembling of remembrance poppy. The Royal British pronunciated about, saying that was ‘sick and degenerate’ before its release trying to ban the game. A newspaper quoted the British Legion, Liberal Democrat MP Menzies Campbell and Viscount Montgomery of Alamein, calling the game offensive to “millions”, “monstrous” and “very unfortunate” respectively.

In the run-up to Remembrance Day, it has become common for UK football teams to play with artificial poppies sewn to their shirts, at the request of the Royal British Legion. This has caused some controversy. At a Celtic v Aberdeen match in November 2010, a group of Celtic supporters, called the Green Brigade, unfurled a large banner in protest at the team wearing poppies.

In a statement, it said:

“Our group and many within the Celtic support do not recognise the British Armed Forces as heroes, nor their role in many conflicts as one worthy of our remembrance”.

 

It gave Operation Banner (Northern Ireland), the Afghanistan War and the Iraq War as examples. In November 2011, it was proposed that the England football team should wear poppies on their shirts in a match against Spain. However, FIFA turned down the proposal, saying it would “open the door to similar initiatives” across the world, “jeopardising the neutrality of football”.

FIFA’s decision was attacked by Prince William and Prime Minister David Cameron, who said he would back any player who ignored the ban.

Members of the English Defence League (EDL) held a protest on the roof of FIFA’s headquarters in Zurich. Instead, the English Football Association came up with other ways to mark Remembrance Day; for example, the England players would wear poppies before kickoff and black armbands during the match, there would be a minute’s silence, a poppy wreath would be set on the pitch during the national anthems, poppies would be sold in the stadium and would be shown on the scoreboards and advertising boards.

FIFA subsequently allowed the English, Scottish and Welsh teams to wear poppies on black armbands. Irish footballer James McClean, who has played for a number of English teams, has received death threats and abuse since 2012 for refusing to wear a poppy on his shirt during matches. McClean is from Derry, where British soldiers shot dead 14 unarmed civilians on Bloody Sunday.

Other public figures have also been attacked for not wearing poppies. British journalist and newsreader Charlene White has faced racist and sexist abuse for not wearing a poppy on-screen. She explained “I prefer to be neutral and impartial on screen so that one of those charities doesn’t feel less favoured than another”.

Newsreader Jon Snow does not wear a poppy on-screen for similar reasons. He too was criticized and he condemned what he saw as “poppy fascism”. Well-known war-time journalist Robert Fisk published in November 2011 a personal account about the shifting nature of wearing a poppy, titled

“Do those who flaunt the poppy on their lapels know that they mock the war dead?”.

British Prime Minister David Cameron rejected a request from Chinese officials to remove his poppy during his visit to Beijing on Remembrance Day 2010. The poppy was deemed offensive because of its association with the Anglo-Chinese Opium Wars in the 19th century, after which the Qing Dynasty was forced to tolerate the British opium trade in China and to cede Hong Kong to the UK.

However, Cameron wore a poppy in October 2015 when he met Chinese President Xi Jinping in London.

A 2010 Remembrance Day ceremony in London was disrupted by members of Muslims Against Crusades, who were protesting against British Army actions in Afghanistan and Iraq. They burnt large poppies and chanted “British soldiers burn in hell” during the two-minute silence. Two of the men were arrested and charged for threatening behaviour. One was convicted and fined £50.

The same group planned to hold another protest in 2011, but was banned by the Home Secretary the day before the planned protest.

In recent years, people have been arrested in the UK for burning remembrance poppies. In November 2011 a number of people were arrested in Northern Ireland after a picture of two youths burning a poppy was posted on Facebook. The picture was reported to police by a member of the RBL.

The following year, a young Canterbury man was arrested for allegedly posting a picture of a burning poppy on Facebook, on suspicion of an offence under the Malicious Communications Act.

In 2011 it was revealed that Kleshna, one of two businesses selling its own poppies on the RBL website, gives only 10% of its sales to charity. Kleshna sells crystal-clad poppy jewellery which has been worn by celebrities on television

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Visit the website or make a donation:

www.britishlegion.org.uk

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Japanese war crimes – Execution of Leonard Siffleet

Execution of  Leonard Siffleet

14 January 1916 – 24 October 1943

With VJ around the corner I thought I would do a  post about Leonard Siffleet , whose lonely end was immortalised in this famous picture. When I first saw this picture I was struck by how calm and dignified Leonard seemed as he waited on the brutal end to his too short life. His sacrifice and death will live long in our memory. I salute you Leonard!

Leonard George (Len) Siffleet

Leonard George (Len) Siffleet
P02547.001SiffleetPortrait.jpg
Studio portrait of Len Siffleet, c. 1941
Born(1916-01-14)14 January 1916

Gunnedah, New South Wales

Died24 October 1943(1943-10-24) (aged 27)

Aitape, Papua New Guinea

AllegianceAustralia
Service/branchAustralian Army
Years of service1940–43
RankSergeant
UnitSRD (1942–43)
Battles/warsWorld War II

Leonard George (Len) Siffleet (14 January 1916 – 24 October 1943) was an Australian commando of World War II. Born in Gunnedah, New South Wales, he joined the Second Australian Imperial Force in 1941, and by 1943 had reached the rank of sergeant. Posted to M Special Unit of the Services Reconnaissance Department, Siffleet was on a mission in Papua New Guinea when he and two Ambonese companions were captured by partisan tribesmen and handed over to the Japanese.

All three men were interrogated, tortured and later beheaded. A photograph of Siffleet’s impending execution became an enduring image of the war, and his identity was often confused with that of other servicemen who suffered a similar fate, in particular Flight Lieutenant Bill Newton, VC.

Early life

Siffleet and fiancée Clarice Lane, 1941

Len Siffleet was born on 14 January 1916 in Gunnedah, New South Wales. The son of an itinerant worker of Dutch ancestry,  his siblings included a sister and two brothers. Siffleet made his way to Sydney in the late 1930s, seeking to join the police force, but was prevented from doing so because of his eyesight. He was nevertheless called up for the militia in August 1940, and attached to a searchlight unit at RAAF Station Richmond.

Discharged from the militia after three months, Siffleet returned to his family to help look after his young brothers following their mother’s death. He was working as a shop assistant when he enlisted in the Second Australian Imperial Force (AIF) in September 1941.

Allotted to a signals company based at Ingleburn, New South Wales, he was reported absent without leave on two occasions; he was by this time engaged to Clarice Lane.

New Guinea campaign

After training in radio communications at Melbourne Technical College, Siffleet volunteered for special operations in September 1942 and was posted to the Services Reconnaissance Department (SRD) of the Allied Intelligence Bureau in Melbourne.[1][4] He joined Z Special Unit in October and was transferred to Cairns in Far North Queensland for further operational training. Assigned to the SRD’s Dutch section as a radio operator, Siffleet was promoted sergeant in May 1943. He moved across to M Special Unit the same month to take part in a mission to set up a coastwatching station in the hills behind Hollandia in Papua New Guinea.[1][3] Described by Commander Eric Feldt, director of the Coastwatchers, as “the best type of N.C.O. of the A.I.F., young and competent”. 

Siffleet joined a party led by Sergeant H. N. Staverman of the Royal Netherlands Navy, which included two Ambonese privates, H. Pattiwal and M. Reharing. Code-named “Whiting”, this team was to work in concert with another group known as “Locust”, led by Lieutenant Jack Fryer.

Staverman’s reconnaissance group commenced its mission in north-east New Guinea in July, trekking across mountainous terrain through August and September. At some point Staverman and Pattiwal separated from the others to undertake further exploration of the countryside, and were ambushed by a group of natives. Both were captured and reported as killed, but Pattiwal later escaped and rejoined Siffleet and Reharing. Siffleet signalled Fryer to warn him of the hostile natives and of Japanese patrols, indicating that he was preparing to burn his party’s codes and bury its radio. No more was heard from them after early October.

Clarice Lane (incorrectly addressed as “Clemice” Lane) had in the meantime received two letters from the Allied Intelligence Bureau in July and September, stating that Siffleet was “safe and well”.

Death and legacy

Sergeant Siffleet’s execution at Aitape, 1943

After Pattiwal rejoined Siffleet and Reharing, they attempted to make their way to the Dutch border. They were ambushed by a hundred native villagers near Aitape and, after a brief melée during which Siffleet shot and wounded one of their attackers, the group was captured and handed over to the Japanese. Interrogated and tortured, the team was confined for approximately two weeks before being taken down to Aitape Beach on the afternoon of 24 October 1943.

Bound and blindfolded, surrounded by Japanese and native onlookers, they were forced to the ground and executed by beheading, on the orders of Vice-Admiral Michiaki Kamada of the Imperial Japanese Navy.

The officer who executed Siffleet, Yasuno Chikao, detailed a private to photograph him in the act.  Chikao has been variously reported as having died before the end of the war, and as having been captured and sentenced to be hanged, with his sentence subsequently commuted to 10 years’ imprisonment. 

The photograph of Siffleet’s execution was discovered on the body of a dead Japanese major near Hollandia by American troops in April 1944. It is believed to be the only surviving depiction of a western prisoner of war being executed by a Japanese soldier.

The photo was published in Australian newspapers and in Life magazine but was thought to depict Flight Lieutenant Bill Newton VC, who had been captured in Salamaua, Papua New Guinea, and beheaded on 29 March 1943.

It later went on display at the Australian War Memorial. Elsewhere, despite positive identification in 1945 of Siffleet as the soldier pictured, the image continues on occasion to be misidentified as Newton.

Siffleet is commemorated on the Lae Memorial in Lae, Papua New Guinea, together with all other Commonwealth war dead from actions in the region who have no known grave.A memorial park commemorating Siffleet was also dedicated at Aitape in May 2015.

R.I.P

See: Execution of Bill Newton – Life & Death